Are we following the European charter? Children, parents and staff perceptions

Assessing the Respect of Children's Rights in Pediatric Hospitals

Background and Objectives: In 1989, the United Nations (UN) General Assembly adopted the United Nations Convention on the Rights of the Child (UNCRC), with a considerable number of the Articles of the Convention being related to the health status of children. Therefore, adhering to and assessing the implementation of the rights of children during hospitalization is a very important step towards child protection. Herein, we attempt to highlight the depth of knowledge of employees working in children's hospitals with regard to children's rights as well as the degree of adherence to the UNCRC with respect to hospitalized children. Material and Methods: The target group included all healthcare professionals working in the various general pediatric clinics of the three Children's Hospitals of the Athens metropolitan area in Greece. We conducted a cross-sectional study, with data collection carried out in February and March 2020, using a structured questionnaire consisting of 46 questions which was handed out to all personnel. For the analysis, we used the IBM SPSS 21.0. Results: A total of 251 individuals participated in the study (physicians 20%, nurses 72%, and other employees 8%). A total of 54.5% of health professionals did not know what the UNCRC is, and 59.6% of them were not even aware that their hospital had rules and a bioethical committee related to clinical research involving children. Lack of awareness or trust of health professionals is also observed for other procedures or supervisory measures such as abuse protocols, complaint control, admission control, etc. With regard to the health system, there are shortcomings or weaknesses in (a) procedures followed with regard to respect for gender and privacy, (b) information on basic services provided by pediatric hospitals (such as recreation, education and free meals during hospitalization), (c) the logistical infrastructure (such as recreational facilities and facilities for the disabled), (d) the possibility of recording complaints, and (e) hospitalizations that were not necessary. A difference emerged concerning the nurses' responses between the three hospitals, with nurses participating in relevant seminars held in one of the hospitals being significantly more informed. Conclusions: The majority of healthcare personnel seem unaware of basic principles with respect to children's rights during hospitalization as well as relevant procedures and supervisory measures. Moreover, obvious weaknesses of the health system exist with respect to procedures, services, infrastructure, and complaint recording. There is a need for improved education of health professionals with respect to the implementation of children's rights in pediatric hospitals.

Implementing Article 12 of the United Nations Convention on the Rights of the Child in health care: a scoping review

Purpose

The purpose of this paper is to present the results of a scoping review on the implementation of Article12 in health care. The scoping review will provide a summary and overview of the key concepts and published literature on this topic internationally. Article 12 of the United Nations Convention on the Rights of the Child (1989) states that children have a right to express their views, to have them heard and for their views to be given due weight in all matters that affect them. Despite increased calls for Article 12 to be given attention in health care, there is little evidence to suggest this has been well implemented and embedded in Australian health-care delivery. The scoping review was undertaken to provide a summary and overview of the key concepts and published literature on this topic internationally.

Design/methodology/approach

A five-step methodological framework described by Arksey and O’Malley (2005) was used to undertake the scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used as a guideline for undertaking the study selection.

Findings

Children are still not routinely involved in health-care decision-making, are frequently left out of service planning and evaluation and the perception that they lack the capability to make rational decisions persists.

Originality/value

While there has been a focus on research that investigates children’s participation in health-care decision-making in recent years, there is little that directs attention specifically to the implementation of Article 12, particularly in Australian health care. Recommendations are made for further research in these areas.

Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses

BACKGROUND

Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice.

PURPOSE

The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses.

METHODS

This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments.

RESULTS

Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices ( r =-0.199, P < .001).

IMPLICATION FOR RESEARCH AND PRACTICE

Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.

[Children's rights in Austrian hospitals: implementation factors for children's participation]

Background

Various studies show that it is important for children and adolescents (as well as their parents) to be involved and have a say in decisions regarding treatment. Nevertheless, it seems that participation processes are not necessarily implemented into hospital routines everywhere. So far, no study has been conducted on the implementation of children's rights or participation in Austrian hospitals.

Objective

Our study aimed at investigating the extent to which children's rights (especially the right to participation) and the European Association of Children in Hospital (EACH) Charter are known in Austrian hospitals, how they are implemented, and which facilitating and hindering factors can be identified.

Methods

A questionnaire survey was conducted among the chief medical and nursing staff on wards where children and adolescents are treated (n = 133), and qualitative interviews were conducted with experts on children's rights, medical and nursing staff, parents and one adolescent girl (n = 15). The results and recommendations for action that were derived from the data were discussed and validated in an expert workshop.

Results

The medical and nursing staff in Austrian children's and adolescents' wards are already doing a lot to implement and uphold children's rights. There is awareness of the need for child-centered treatment and the need to allow children and adolescents to participate during their hospital stay. Nevertheless, the interviews with parents show that there are large differences between hospitals and that there is still a lot to be done.

Conclusion

Based on the results, three areas for recommendations for action were identified: 1) anchoring children's rights, both legally and in the training of medical and nursing staff, 2) strengthening the team and feedback culture, e.g., through more staff resources for good teamwork and 3) good health information and good conversation quality. This means that health information for children and adolescents should be quality assured, comprehensible, evidence-based and on aspects relevant to them. Conversations between health professionals and patients and their relatives, should be patient-centered, which can be promoted through training, introduction of quality standards and guidelines.

Pediatric hospital care organization: Cross-sectional enquiry in four regions in France

OBJECTIVE

The aim of this study was to characterize conventional pediatric care capacities in French public hospitals and identify the main difficulties in guiding upcoming health policies. The secondary objective was to assess the quality of care by the implementation of the European Charter of the Rights of Children in Hospital.

METHOD

Multicenter cross-sectional study using a questionnaire survey sent by e-mail to the heads of conventional pediatric departments in four French regions identified on the French Hospital Federation's website. The survey was conducted between 25 September and 25 October 2018.

RESULTS

Fifty-six of 113 heads of departments participated in the survey. The mean annual number of admissions per unit in 2017 was 2066 (SD, 1433), with a median length of stay of 2.7 days (range, 1-10). Children were admitted up to age 18 years in 76% of the departments, and 83% of the departments had an individualized pediatric emergency department. The nurse care load was very high, specifically during the night shift (9.5 patients/nurse). Inpatient education and academic teaching were unavailable in 38% of the departments. Overall, 89% of department heads declared knowing the European Charter of the Rights of Children in Hospital, and a copy of it was posted in all units in 57% (95% confidence interval, 44-70) of the services/departments. At all times and in all departments, parents were allowed to be with their children, and for 34% (95% CI, 21-47) of the departments, an accommodation for parents was available close to the hospital.

CONCLUSION

Public hospital pediatric departments lack sufficient medical and nonmedical caregivers. Department heads were well aware of the European Charter, and it was well disseminated but should be updated to address today's challenges in pediatrics. An area of improvement would be to include parents in their child's care more effectively.

Interação equipe de enfermagem, família, e criança hospitalizada: revisão integrativa

Resumo Este estudo tem o objetivo de apresentar uma revisão integrativa de artigos científicos, referentes à produção nacional e internacional, sobre interação equipe de enfermagem, família, e criança hospitalizada. Foram realizadas consultas nas bases de dados Bireme, Lilacs, Medline, IBECS, Psyc Info, Science Direct, e Web of Science (2008-2013), o que permitiu identificar 31 artigos, os quais são representados pelos seguintes eixos temáticos: Relação interpessoal, Comunicação e Cuidado. O estabelecimento de relações interpessoais, de maneira técnica e formal, ocasiona dificuldades na comunicação e nas ações destinadas ao cuidado. O cuidado foi o tema predominante nestas pesquisas, acompanhantes reivindicam dos profissionais de saúde uma atenção ampliada às necessidades da criança e da família, e maior envolvimento de todos no processo de cuidado. Os resultados sugerem a necessidade da equipe de saúde reconhecer a dinâmica vivenciada pela díade (criança/acompanhante), para que possibilite desenvolver a atenção integral que favoreça a inclusão da família e da criança por meio de estratégias de humanização.

Primerjava poznavanja otrokovih pravic med starši hospitaliziranih otrok in medicinskimi sestrami

Uvod: Pravice bolnih otrok imajo v modernih družbah status samostojnih pravic, ki jih je potrebno upoštevati in ustrezno varovati. Odvisne so od razvitosti družbe in zmogljivosti zdravstvenega sistema in bi jih morali poznati zdravstveni delavci, starši, skrbniki in otroci. Namen raziskave je bila primerjava poznavanja pravic otrok v bolnišnici med starši hospitaliziranih otrok in medicinskimi sestrami. Metode: Uporabljena je bila neeksperimentalna metoda raziskovanja, podatki so bili zbrani z strukturiranim vprašalnikom na vzorcu staršev hospitaliziranih otrok (n = 49) in medicinskih sester (n = 60). Vprašalnik je bil predhodno testiran. Za analizo zbranih podatkov smo uporabili osnovno deskriptivno statistiko ter bivariatno analizo (test hi-kvadrat, t-test). Rezultati: Raziskava pokaže statistično značilne razlike med starši in medicinskimi sestrami v stopnji seznanjenosti s pravicami bolnih otrok, ki temeljijo na Listini Evropskega združenja za pravice otrok v bolnišnicah (t = 5,828, p < 0,001). Diskusija in zaključek: Poznavanje pravic otrok v bolnišnici je višje pri medicinskih sestrah kot pri starših hospitaliziranih otrok. Razlike so največje glede poznavanja načina komunikacije medicinskih sester s starši, glede razporeditve otrok na oddelke in ustvarjanja pogojev za igro ter izobraževanje v času bivanja v bolnišnici in glede pogojev sprejema v bolnišnico. Med obema skupinama ni razlik v oceni tega, v kolikšni meri se pravice otrok, ki temeljijo na Listini Evropskega združenja za pravice otrok v bolnišnicah, spoštujejo, obe skupini ocenjujeta, da je stopnja spoštovanja pravic dokaj visoka.

Actual implementation of sick children's rights in Italian pediatric units: a descriptive study based on nurses' perceptions

Background

Several charters of rights have been issued in Europe to solemnly proclaim the rights of children during their hospital stay. However, notwithstanding such general declarations, the actual implementation of hospitalized children’s rights is unclear. The purpose of this study was to understand to which extent such rights, as established by the two main existing charters of rights, are actually implemented and respected in Italian pediatric hospitals and the pediatric units of Italian general hospitals, as perceived by the nurses working in them.

Methods

Cross-sectional study. A 12-item online questionnaire was set up and an invitation was sent by email to Italian pediatric nurses using professional mailing lists and social networks. Responders were asked to score to what extent each right is respected in their hospital using a numeric scale from 1 (never) to 5 (always).

Results

536 questionnaires were returned. The best implemented right is the right of children to have their mothers with them (mean score 4.47). The least respected one is the right of children to express their opinion about care (mean 3.01). Other rights considered were the right to play (4.29), the right to be informed (3.95), the right to the respect of privacy (3.75), the right to be hospitalized with peers (3.39), the right not to experience pain ever (3.41), and the right to school (3.07). According to the majority of nurses, the most important is the right to pain relief.

Significant differences in the implementation of rights were found between areas of Italy and between pediatric hospitals and pediatric units of general hospitals.

Conclusion

According to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited.

Socio-linguistic analysis of the Charter of Citizens' Rights and Obligations in Health Services

The aim of this study is to carry out a socio-linguistic analysis of the dissemination of the Charter of Citizens' Rights and Obligations in Public Health Services. We designed a qualitative investigation using observation and content analysis. A deductive analysis technique was followed, based on the "SPEAKING" model categories. The data analysis suggests a clear framework of rights and obligations has been established, but is not very familiar to patients and relatives. We can conclude that despite the widespread dissemination and publicity of the Citizens' Charter of Rights and Obligations, we still need the involvement of professionals. Nurses can develop a fundamental role in this process.

Ascertaining children's wishes and feelings about hospital life

It is increasingly accepted that children have the right to have their views taken into consideration by healthcare providers. Children's opinions and experiences of hospitalisation are essential for monitoring and evaluating the effectiveness of health services provision. In this paper we report on children's views and wishes about hospital and healthcare professionals. The children held both positive and negative views of hospital and healthcare professionals. Dissatisfaction was caused by insufficient information, lack of involvement, and inadequate play facilities. Their wishes were mainly concerned with the need for more information and more involvement in communication interactions with doctors and nurses. They wished to express their opinions, ask questions and receive information about care and procedures. They recommended that healthcare professionals make a better effort to listen and to take account of their views.

Parental presence during child resuscitation: a critical review of a research article

The article reviewed is: Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study (Maxton 2008). The article provides an insight into parents' experiences of being present or absent during successful or unsuccessful resuscitation attempts on their child. It can help healthcare practitioners to understand what parents' perspectives and needs may be during this difficult time. Lack of such understanding could potentially lead healthcare practitioners to neglect or misjudge the parents' needs and apply inappropriate interventions which may result in long-lasting and detrimental effects on parental welfare (Dingeman et al 2007). Patient care on this particular occasion extends to a family and therefore it becomes a professional duty of the healthcare practitioners to ensure best practice through provision of a well informed support (HPC 2008).

How children's rights are constructed in family-centred care: a review of the literature

It appears that the acceptance of children's rights within the acute care setting is treated as a given but such a given requires a more systematic analysis. This has been undertaken here in the form of a review of the literature. The purpose of the review is to explore how children's rights, defined by the United Nations Convention on the Rights of the Child (UNCRC) are recognized in family-centred care in the acute care paediatric setting as reported in the literature. Reports that were available from 1989 to 2010 were reviewed. Children's rights are not mentioned frequently in the literature of interest to children's nurses. What is revealed are the ethical tensions in the challenge to act at all times in children's best interests (in the spirit of Article 3) while giving due weight to their views (in the spirit of Article 12) (OHCHR, 1989). The continuing failure to address these tensions undermines the spirit and practice of family-centred care.